AAP Section on Orthopaedics | Global Outreach Scholarship Application
Submission period: July 1 through November 1 for trips taken during the following calendar year. Deadline to apply: November 1. Notifications by December 31.
Name
*
First Name
Last Name
Age
*
Gender
*
Year you will finish your orthopaedic residency or pediatric orthopaedic fellowship
*
Hospital / practice / institution
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your permanent address (if different from mailing address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell phone
*
-
Area Code
Phone Number
Primary email address
*
Residency program director/ fellowship director - Name
*
(formal letter of recommendation required from this person)
Physician mentor- Name
*
(formal letter of support required from this person if different from residency program director/fellowship director)
Physician mentor- Institution
*
Physician mentor- Program
*
Physician mentor- Email
*
example@example.com
Proposed host country and city/region
*
Proposed departure and return dates
*
What are your local housing arrangements?
*
Appendix A: Attach photocopy of your passport (and visa, if necessary)
*
Appendix B: Attach documentation of immunizations (if required) for host country
*
Appendix C: Letter of recommendation from residency program director or fellowship director
*
(if not the same person as the physician mentor, below.) Additional letters of reference are welcomed but not required.
Appendix D: Letter from physician mentor with a summary of the proposed trip – 500 words or less on the needs of the country/region, tentative timeline, target patient population, and list of local leaders and sponsoring organizations that have agreed to assist in this effort.
*
Fill out and attach the photo release form found here: https://www.aap.org/en-us/Documents/SOOrPhotoAuthorizationRelease.pdf
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Provide a general overview of the proposed trip.
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(500 words or less, expand text box as needed)
Please describe the work that you will be doing in the host country - what orthopedicconditions/settings do you anticipate seeing and what will your role be?
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(500 words or less, expand text box as needed)
Describe any previous international experience you’ve had.
*
(500 words or less, expand text box as needed)
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